4

MEDICAL EXPERT

  1. The resident demonstrates knowledge of:

1.  Physiology of normal lung function and gas exchange.

2.  Principles of and indications for mechanical ventilation and management of patients requiring mechanical ventilation.

3.  Pathophysiology of respiratory failure, hemodynamic failure, shock and altered level of consciousness.

4.  Physiology and pathophysiology of fluid and electrolyte balance and principles of management.

5.  Pathophysiology and management of cardiorespiratory arrest.

6.  Principles of resuscitation and management of patients with multi-system trauma.

7.  Pathophysiology of sepsis and coagulation disorders with the ICU.

8.  Pathophysiology and management of ICU related infections.

9.  Understanding and interpretation of non-invasive and invasive cardiorespiratory monitoring.

10. Pathophysiology and management of major metabolic derangements (e.g., diabetic ketoacidosis).

11. Principles of rapid sequence induction of endotracheal intubation in the critically ill patient.

12. Principles of sedation and analgesia in the critically ill patient.

13. Determination of brain death and principles of organ donation.

14. Principles of the role of nutritional management in the critically ill patient.

15. Principles of interhospital transport of the critically ill patient.

16. Management of the complex/technology dependent pediatric patient.

  1. The resident demonstrates skill proficiency at:
  1. Recognition and stabilization of the critically ill patient.
  2. Airway management (bag/valve/mask ventilation, endotracheal intubation) and cardiorespiratory resuscitation.
  3. Rapid sequence induction of the critically ill patient.
  4. Insertion and care of indwelling catheters (intravenous, intraarterial, central venous, intraosseous).
  5. Diagnostic lumbar puncture for cerebrospinal fluid drainage and analysis.
  6. Management of the patient with a tracheotomy tube, including tracheotomy tube replacement.

C. The resident was able to perform:

  1. Cervical spine manual immobilization and placement of cervical spine collar.
  2. Immobilization of acute injury/fracture.
  3. Intrahospital transport of the critically ill/intubated patient.
  4. Operation of the defibrillator and technique for delivery of synchronized cardioversion/defibrillation.

D. The resident was able to manage acutely:

  1. Cardiorespiratory arrest
  2. Shock
  3. Respiratory failure
  4. Airway obstruction
  5. Sepsis
  6. Multi-system trauma
  7. Coma
  8. Status epilepticus
  9. Head injury
  10. Apparent life threatening events
  11. Metabolic derangement
  12. Fluid and electrolyte imbalance
  13. Foreign body aspiration
  14. Burn management
  15. Submersion injury
  16. Poisonings and drug overdose
  17. Anaphylaxis
  18. Coagulopathy
  19. Renal failure
  20. Hepatic failure

E. The resident was able to complete:

  1. Rapid, pointed examination of airway, breathing and circulation.
  2. Thorough examination of upper airway, cardiorespiratory and abdominal systems.
  3. A systematic approach to the primary and secondary survey in the pediatric trauma patient.

COMMUNICATOR

1.  Ability to elicit a succinct and relevant history of presenting illness for the critically ill patient.

2.  Demonstrates the ability to interact and communicate with family members of critically ill patients.

3.  Effective and sensitive communication with families experiencing the expected or unexpected death of a child.

4.  Demonstrates knowledge of and proficiency taking an “AMPLE” history.

5.  Able to prioritize between the need for an accurate and thorough history and the requirement for necessary resuscitative management.

6.  Maintains clear and open communication with the entire health care team regarding suspected diagnosis, ongoing management plans and further investigation.

7.  Communication of sudden changes in clinical status to the most responsible staff physician.

8.  Thorough handover of all patients being transferred out of the Pediatric Intensive Care Unit.

9.  Up-to-date written documentation of patient progress, including daily progress notes, and documentation of change in status or implementation of new therapy or procedure.

10. Able to present a clear and concise summary of the presenting history, clinical findings and management plan.

11. Participation in all family meetings.

12. Communication of patient status to referring MD and most responsible community physician within 24 hours of admission and at time of discharge.

COLLABORATOR

The resident must:

1.  Demonstrate an ability and willingness to collaborate with the entire health care team including sub-specialty medical and surgical services, nursing staff and all allied health care staff.

2.  Demonstrate initiative in seeking the input of members of the health care team where appropriate.

3.  Exhibit effective communication with all members of the health care team.

4.  Demonstrate initiative in acting as a liaison between family members and the health care team.

MANAGER

1.  Appropriate transfer of patients into and out of the Intensive Care Unit to facilitate bed management issues.

HEALTH ADVOCATE

1.  Recognizes quality of life issues amongst critically ill children and promotes discussion of these issues with the health care team and family in the context of the patient's care plan.

2.  Demonstrates effective utilization of social work and community resources to facilitate transition of technology dependent patients out of the ICU setting.

3.  Demonstrates awareness of issues surrounding family's decision to consent to organ donation in brain dead patient.

4.  Recognizes possible non-accidental injury and communicates such to the McMaster Children’s Hospital CAAP team and CAS.

SCHOLAR

1.  Demonstrates a proficiency with electronic literature searches.

2.  Utilizes evidence-based current standards in day-to-day patient management.

PROFESSIONAL

1.  Demonstrates sensitivity around the management of critically ill children, recognizing the emotional impact on family members.

2.  Demonstrates compassion, caring and sensitivity with families dealing with the loss of a child.

3.  Recognizes the various ways in which the death of a child may impact family members, including siblings, and uses appropriate resources to support families as needed.

4.  Demonstrates respect for patient and family wishes surrounding end of life decision-making and makes every attempt to support patient and family decisions in this regard.

5.  Takes into consideration ethical issues surrounding invasive procedures and therapies in the critically ill patient.

6.  Recognizes personal limitations within the field of critical care and demonstrates a willingness to seek out and accept support of critical care or other sub-specialty staff in a timely manner.

Modified: August 10, 2007